MEDICARE: EDWYNA I ALEXANDER SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4288	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4288	OTHER	NM	NEW MEXICO REGULATING & LICENSING DEPARTMENT
2	16424	OTHER	TX	STATE BOARD
3	89044T	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1073611174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWYNA I ALEXANDER SLP

Provider Business Mailing Address
First Line	:	4001 OFFICE CT
Second Line	:	SUITE 305
City	:	SANTA FE
State	:	NM
Zip	:	87507-4929
Country	:	US
Telephone Number	:	505-466-7710
Fax Number	:	505-466-7714

Provider Business Practice Location Address
First Line	:	4001 OFFICE CT
Second Line	:	SUITE 305
City	:	SANTA FE
State	:	NM
Zip	:	87507-4929
Country	:	US
Telephone Number	:	505-466-7710
Fax Number	:	505-466-7714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/27/2008

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Directions to “ EDWYNA I ALEXANDER SLP” Practice Location

Language	Start Address	Practice Location

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